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General NPI Number Information
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NPI Number | 1578961140
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Entity Type | Individual
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Provider Name | RAISA LONG D.C.
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Gender | Female
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Dates
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Enumeration Date | 12/15/2014
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Last Update Date | 03/25/2020
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Provider Practice Location Address
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Address Line | 1401 DOUG BAKER BLVD # 107-178
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City | BIRMINGHAM
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State | AL
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Zip | 35242-4974
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Country | US
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Telephone | 205-737-9255
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Fax | 205-737-9258
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Provider Business Mailing Address
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Address Line | 1401 DOUG BAKER BLVD STE 107-178
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City | BIRMINGHAM
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State | AL
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Zip | 35242-4974
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Country | US
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Telephone | 205-737-9255
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Fax | 205-737-9258
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2450
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License Number State | AL
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